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General NPI Number Information
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NPI Number | 1164530952
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Entity Type | Organization
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Legal Business Name | DOUGLAS W. BEAL, MD AND ASSOCIATES, PC
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Dates
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Enumeration Date | 08/29/2006
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Last Update Date | 01/05/2014
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Provider Practice Location Address
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Address Line | 2412 FORUM BLVD SUITE 201
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City | COLUMBIA
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State | MO
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Zip | 65203-6364
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Country | US
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Telephone | 573-445-0725
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Fax | 573-445-1027
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Provider Business Mailing Address
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Address Line | 2412 FORUM BLVD SUITE 201
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City | COLUMBIA
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State | MO
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Zip | 65203-6364
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Country | US
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Telephone | 573-445-0725
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Fax | 573-445-1027
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. DOUGLAS WAYNE BEAL
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Credential | M.D., M.S.H.A.
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Telephone | 573-445-0725
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number |
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License Number State |
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